PNEUMONIA in preventive aspect based on PARK'S TEXT BOOK OF PREVENTIVE & SOCIAL MEDICINE

1. PNEUMONIAPNEUMONIA
Prepared by
ASWATHI C K
3rd YEAR BAMS

2. What is pneumonia?
 Pneumonia
 Infection of the lungs.
 Alveoli fill with fluid and pus, making
breathing more difficult.
 Pneumococcal pneumonia
 Caused by bacteria called pneumococcus
(Streptococcus pneumoniae).
 Can also be caused by other bacteria,
viruses, fungi, parasites.

3. EPIDEMOLOGICAL DETERMINANTS
• AGENT FACTOR
Bacteria : Most common
Streptococcus pneumoniae
Streptococcus pyogenes
Legionella pneumophila
Klebsiella pneumoniae
Virus : Respiratory syncycial virus
Influenza A,B
Parainfluenza 1-3
Adenoviruses
Other agents Clamydia type B
Coxiella burntti
Mycoplasma pneumoniae

4. AGENT......
• There are more than 100 strains of
infectious agents identified, only a few are
responsible for the majority of the cases
• Mixed infections with both viruses and
bacteria may occur in up to 45% of
infections in children
• agent may not be isolated in
approximately half of cases despite
careful testing

5. STREPTOCOCCUS PNEUMONIAE
• Gram-positive, alpha-hemolytic, facultative
anaerobic bacteria
• resides asymptomatically in the
nasopharynx of healthy carriers

6. Reservoir
• Exclusively a human pathogen; no animal or
environmental reservoir
Carrier
• Carried in the nasopharynx of 40-70% of
humans without symptoms.
Portal of entry
• Respiratory tract
Infecting body parts
• respiratory tract, sinuses, and nasal cavity

7. HOST FACTOR
• Case fatality rates are higher in young
infants & malnourished children
• Rate more in children <5yrs & adults older
than 75yrs
• In developing countries,rate is highest due
to malnutrition & low birth weight
• In developed countries RI are less fatal

8. RISK FACTORS
Developing countries : overcrowded dwellings, poor
nutrition
low birth weight, intense indoor smoke pollution
Developed countries : school going children to
- household
 People with some medical conditions are at higher
risk for pneumonia, including: heart disease, lung
disease, diabetes, etc.
 Smoking also increases risk of developing
pneumonia.

9. ENVIRONEMENT
• More common in winter & early spring
• Overcrowding
• Diminished host resistance

10. MODE OF TRANSMISSION
Direct transmission(person to person)
Normally by the airborne route(droplets)-
sneezing,coughing.....
INCUBATION PERIOD
1-4 Weeks

11.  Most cases of pneumonia are spread
person-to-person by coughing out of
tiny droplets.
 Some pathogens can live in nose and
throat without causing disease.
 But when inhaled into lungs, they can
cause pneumonia.
 While many people are exposed to
pneumococcus, usually only those with
underlying health issues develop
pneumonia.

12. PATHOGENESIS
• bacteria invade the spaces between cells
and between alveol
• macrophages and neutrophils attempt to
inactivate
• neutrophils cytokines activate immune
system fever, chills, and fatigue
• neutrophils, bacteria, and fluid from
surrounding blood vessels fill the alveoli,
resulting in the consolidation

13. TYPES OF PNEUMONIA
Pneumonia affects your lungs in two
Ways .
According to areas involved :
 Lobar pneumonia : affects a
section (lobe) of a lung.
 Bronchial pneumonia
(Bronchopneumonia) :
affects patches throughout both lungs.

14. LOBAR PNEUMONIA

15. BRONCHOPNEUMONIA
(Bronchitis and Pneumonia occur together)

16. CLINICAL MANIFESTATIONS

17. SIGNS AND SYMPTOMS
 High fever, Shaking Chills
 Shortness of breath (Dyspnoea)
 Increased breathing rate
 Chest pain when you breathe deeply or
cough
 Dusky or purplish skin colour (cyanosis)
from poorly oxygenated blood
 Fatigue and muscle aches
 Nausea, vomiting or diarrhoea
 Cough, particularly cough productive of
sputum

18. SIGNS AND SYMPTOMS
 Streptococcus pneumoniae: Rust-colored sputum
Pseudomonas, Haemophilus, and pneumococcal species:
May produce green sputum
Klebsiella species pneumonia: Red currant-jelly sputum
Anaerobic infections: Often produce foul-smelling or bad-
tasting sputum
Newborns and infants may not show any sign of the
infection. Or they may vomit, have a fever and cough,
appear restless or tired and without energy, or have
difficulty breathing and eating.
Older people who have pneumonia sometimes have
sudden changes in mental awareness.

19. COMPLICATIONS
 Bacteria in the bloodstream (bacteremia)
 Lung abscess.
 Build up of fluid in the space between the lung and chest wall
(pleural effusion).
 Difficulty breathing.
 Shock and respiratory failure
 Septic arthritis
 Endocarditis

20. DIAGNOSIS
• History taking and clinical assessment
• Physical examination
• X-ray findings of lobar consolidation
• Leukocytosis
• Bacteriological confirmation
Sputam-gram staining & culture
Blood culture

21.  PHYSICAL EXAMINATION
• Count the breath in one minute
• Look for chest indrawing
• Look & listen for stridor
• Look for wheeze
• See if the child is abnormally sleepy or
difficult to wake
• Feel for fever
• check for severe malnutrition
• Look for cyanosis

22. CONTROL
• Improving the primary medical care
services
• Developing better methods for early
detection,treatment & where possible
prevention
• Education of mother

23. PREVENTION
• Better nutrition
• Reduction of smoke pollution
• Better MCH care
• Immunization
Measles vaccine
Hib vaccine
Pneumococcal pneumonia vaccine

24. • Measles:
Dose : 0.5 ml age : 9th month
• Hib vaccine:
Dose : combined with DPT & polio myelitis
Age : 6,10,14th week
Booster dose:12-18 months
• Pneumococcal pneumonia vaccine
a.PPV23
b.PCV

25. PPV23(Pneumococcal Polysaccharide
Vaccine)
• protects against 23 types of pneumococcus
• Children under 2 yrs of age and immuno
-compromised individuals does not respond
• Recommended for selected groups - who
have undergone splenectomy/sickle cell
disease,
chronic disease of heart,lung,liver,.....DM,
alcoholism,generalized malignancies,organ
transplant,....

26. • Dose : 0.5ml(25microgrms of purified capsular
polysaccharide from each 23 serotypes)
• Site : intra-muscular ,deltoid or as
subcutaneous dose
Protective capsular type specific antibodies
develope by the 3rd week following vaccination
minor adverse effects such as transient
redness & pain at the site of injection occur in
30-50% cases

27. PCV(Pneumococcal conjugate vaccine)
• 2conjugate vaccines : PCV10 & PCV13
• 2 schedules 3 primary doses(3p+0)
2primarydoses+1booster
(2p+1)
• (3p+0) : from 6 weeks of age
interval : 4-8 weeks
given at 6,10,14 weeks or 2,4,6 months
• (2p+1) : 2 primary doses;as early as 6 weeks of
age in infant-interval-8weeks

28. • 4-8 weeks or more b/w primary doses for
infants≥7 months
• 1 booster dose should be given between
9-15 months of age
• mild reactions like erythema and
tenderness in 50% of cases
• HIV +ve and preterm babies : 3p doses in
12 month of age + booster dose in 2nd
yr of life

29. TREATMENT
• COTRIMOXAZOLE
• IM injection of benzyl pencillin,ampicillin or
chloramphenicol
• very severe : provision of oxygen therapy
IM injection of chloramphenicol
IM of Cloxacillin & Gentamycin

30. X-RAYS
Viral pneumonia x-ray

31. X-RAYS
Lobar pneumonia x-ray (RUL)

32. X-RAYS
bronchopneumonia x-ray

33. X-RAYS
Staph pneumonia x-ray